Chemical ablation of pericapsular nerve group with 95% ethanol for pain relief and quality of life in patients with hip osteoarthritis: a prospective, double-blinded, randomised, controlled trial.

Abstract

Chronic hip pain from osteoarthritis greatly diminishes quality of life, and standard treatments often fail to provide sufficient relief. Ultrasound-guided pericapsular nerve group (PENG) neurolysis using ethanol is a minimally invasive technique that may provide extended analgesia. This study evaluated the efficacy and safety of ultrasound-guided 95% ethanol neurolysis of the PENG compared with a sham procedure in patients with chronic hip pain. This double-blinded, single-centre, RCT included 100 patients (median age: 82 yr [IQR 74-89]; 49% male) with chronic hip pain unresponsive to conservative treatments. Participants were assigned to either ethanol neurolysis (n=50) or a sham procedure (n=50). The primary outcome was pain intensity (numeric rating scale [NRS]) assessed at 7 days, 30 days, 3 months, and 6 months. Secondary outcomes included opioid consumption (oral morphine equivalents), quality of life (EQ-5D-5L), and neurological deficits. Ethanol neurolysis significantly reduced NRS scores at all follow-ups (P<0.0001). The mean NRS scores decreased from baseline 6.0 (sd 0.9) to 3.1 (0.8) at 7 days, 2.9 (0.7) at 30 days, 2.8 (0.7) at 3 months, and 3.0 (0.7) at 6 months. Opioid consumption was lower in the neurolysis group at 7 days (median [IQR]: 1.5 [0.5-3.5] mg vs 11.5 [9.1-13.7] mg, P=0.002) and remained reduced through 6 months. Quality of life improved significantly (P<0.0001), and no neurological deficits were observed. Ultrasound-guided ethanol neurolysis of the PENG is a safe and effective intervention for chronic hip pain, providing long-term relief and reducing opioid dependency. Further multicentre trials are needed to validate long-term outcomes. NCT06087588.